My daughter has been trying to stabilize her body for 4 years since she was diagnosed with Hashimoto's Thyroiditis due to her high TPO levels. But she is still very unstable, please any recommendations from her last lab that I have attached here. thank you.
T3 Total 0.78 ng/mL ref 0.84 - 1.72
T3 Free 4.99 pg/ml ref 2.08 - 4.3
T4 Total 8.57 ug/dL ref 4.5 - 12.5
T4 Free 0.97 ng/dL ref 0.89 - 1.76
TSH 3.84 uUI/ml ref 0.4 - 4.0
ac Anti Microsomales (peroxidasa) (TPO) 625 Ul/ml ref until 35
ac Anti Tiroglobulina <20 Ul/ml ref less 40
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leanma
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Total T3 and Total T4 aren't useful tests so I have not commented on them, it's the Free T3 and Free T4 that tell us what we need to know.
Presumably she is on thyroid meds? Can you tell us what and the dose please?
When did she take her last dose before the test? Levo should be 24 hours before test, if taking NDT or T3 then this should be split the day before and last part of dose 8-12 hours before test.
T3 Free 4.99 pg/ml ref 2.08 - 4.3
T4 Free 0.97 ng/dL ref 0.89 - 1.76
TSH 3.84 uUI/ml ref 0.4 - 4.0
TSH is high which suggests undermedication.
FT4 is low in range which, if on Levo only again suggests undermedication.
ac Anti Microsomales (peroxidasa) (TPO) 625 Ul/ml ref until 35
ac Anti Tiroglobulina <20 Ul/ml ref less 40
These confirm her Hashi's and not worth repeating.
Due to her high TSH and low FT4 I think it might be worth trying 100mcg daily for 6 weeks and then retest. Or if you think that's too much then just a couple of extra days at 100mcg. Hopefully her FT3 will come down and be better balanced, as Greygoose says she might be coming out of a hyper swing.
I don't like that word 'stabilisation'. It really isn't the aim of thyroid hormone replacement. You could stabilise with a TSH at 100, or a TSH of 0.1, but I know which would make you feel best. And, that should be the aim, to feel good, no matter what the numbers are.
'Stabilising' with Hashi's is difficult because of the way it work. the more or less constant attacks on the thyroid, causing hormone to be released into the blood in greater or smaller quatities, so that FT4 and FT3 levels can fluctuate - sometimes wildly, sometimes just a little bit. But, very often your blood levels have little to do with the dose.
All we can do is start low doses of thyroid hormone replacement when hypo and slowly increase until we feel well, knowing that blood levels could change at any time, making us feel more or less over-medicated. In which case, we have to learn to adjust our dose ourselves - without involving doctors who know nothing about all that - until we feel hypo again. It's a difficult balancing act. But, as more and more of the thyroid is destroyed, it becomes easier and easier.
Blood test results can be deceiving. Looking at your daughter's results we see conflicting numbers. The TSH is high but so is the FT3. So, it looks like she's either had a recent fluctuation, or is coming down from a Hashi's hyper swing, and the TSH hasn't caught up with the FT3 yet. Blood tests can only be a rough guide at best. So hoping for 'stabilisation' is asking a bit much at this point. And, we just have to accept that, because there's not a lot else we can do.
Levo? In that case, I'm pretty confident that her high FT3 has nothing to do with her dose, and everything to do with her Hashi's. So, trust the TSH: she is under-medicated. Very silly dose, anyway.
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